Are interventions to enhance communication performance in allied health professionals effective, and how should they be delivered? Direct and indirect evidence

Parry R

CRD summary

The review concluded that there was little direct evidence of the effectiveness of communication skills training for allied health professionals. The author's cautious conclusion appeared reasonable, although it was based on a small number of studies with weak study designs.

Authors' objectives

To evaluate the effectiveness of interventions aimed at improving communication performance among allied health professionals.

AMED, CINAHL, EMBASE, MEDLINE, PsycINFO, ERIC, ASSIA, NHS HTA, Education-line, Web of Science Proceedings and Index to Theses were searched from inception to 2006 for studies in English. Search terms were reported. Reference lists and specialist allied health professional journals were also searched for relevant articles. Experts in the field were contacted for additional articles.

Study selection

Eligible studies included a training intervention with a substantial or sole focus on communications skills that were delivered to healthcare workers (at least some of whom were allied health professionals) and where some form of qualitative or quantitative evaluation of effects was reported.

A narrative synthesis was conducted, with additional information provided in a table.

Results of the review

Five studies (152 participants) were included in the review: one controlled pre-post intervention study; one controlled post-intervention only study; two uncontrolled pre-post intervention studies; and one cohort post-only intervention study.

All five studies reported positive effects of interventions. Evidence from two studies (13 participants) suggested that targeted training for qualified clinicians could improve performance and patient outcomes. Two studies in students (physiotherapy and speech and language therapy) reported small statistically significant benefits of interventions that consisted of additional teaching aimed at communication. A third study in physiotherapy students showed some beneficial effects, but the statistical significance was unclear.

Authors' conclusions

There was little direct evidence of the effectiveness of communication skills training for allied health professionals. Further empirical and conceptual understanding about allied health professionals' communication practices were required in order to improve the design, delivery and subsequent evaluation of communication training among healthcare workers.

CRD commentary

The review question was clear, although the inclusion criteria were broadly defined. Several relevant sources were searched and some efforts were made to reduce publication bias. The restriction to studies in English may mean some relevant data was missed. Appropriate methods were used to reduce error and bias in assessment of validity and data extraction; it was unclear whether similar methods were used in the selection of studies for inclusion.

Study quality was assessed using appropriate criteria. However, results of the assessment were not reported and so it was not possible to adequately comment on the reliability of the results presented. A narrative synthesis was appropriate given the differences between studies in terms of study design, interventions, populations and outcomes. Limited details were presented in a table. The lack of numerical and statistical data made the results difficult to interpret. The author's cautious conclusion appeared reasonable, although it was based on a small number of studies with weak study designs.

Implications of the review for practice and research

Practice: The author stated that evidence suggested it was possible to positively influence allied health professional clinician performance and patients' outcomes if training interventions were specific and founded on evidence of effective practice.

Research: The author stated that direct observational research was needed to identify specific practices involved in allied professional consultations to obtain detailed practice-relevant descriptions. Studies whould evaluate functions and effects in order to design training interventions and instruments for measuring their effects. Research was needed also on how specific communication practices impacted patient-related aspects, including perceived quality of care, health-related behaviours and outcomes. Randomised controlled trials of allied health professionals communication skills interventions were likely to produce limited results about practice and its measurement.

Funding

National Institute of Health Research, UK NCCRCD PDA/N&AHP/PD02/038.

Bibliographic details

Parry R. Are interventions to enhance communication performance in allied health professionals effective, and how should they be delivered? Direct and indirect evidence. Patient Education and Counseling 2008; 73(2): 186-195

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.